Healthcare Provider Details

I. General information

NPI: 1508350828
Provider Name (Legal Business Name): KANDYCE D SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16010 JUDSON DR
CLEVELAND OH
44128-2156
US

IV. Provider business mailing address

16010 JUDSON DR
CLEVELAND OH
44128-2156
US

V. Phone/Fax

Practice location:
  • Phone: 216-278-2751
  • Fax:
Mailing address:
  • Phone: 216-278-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC1801449
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: